SPRINT wil randomize approximately 7500 subjects aged ~ 55 years with systolic blood pressure (SSP) ~130 mmHg and at least one additional cardiovascular disease (CVD) risk factor. . The trial will test the effects of intensive SSP lowering compared with standard lowering: a comparison of a SSP goal of c:120 mmHg versus c:140 mmHg for a SSP difference of 10-15 mmHg between the two randomized groups. The primary endpoint is incident CVD events identified over a mean 5 year follow-up. The primary hypothesis is that incident fatal and nonfatal CVD event rates wil be lower in the intensive arm. Secondary hypotheses include whether the lower SSP goal reduces progression of renal disease in a large subgroup with stage 3 chronic kidney disease (CKD), the impact of treatment strategy on health-related quality of life, the relative cost effectiveness of the two strategies, and whether the lower SSP goal wil reduce the rate of cognitive impairment. SPRINT Memory and Cognition In Decreased Hypertension wil test whether the lower SSP goal influences 1) the rate of incident dementia and mild cognitive impairment, 2) global and domain-specific cognitive function, and 3) total and regional brain volumes and ischemic lesion volumes.